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'The free Adobe Raeder may be used to view and complete fine form. However,software must be purchased to complete,save.and muse a caved form. <br /> File Original with OWR State of California DWR Use O -Do Not FBI In <br /> Page 1 of 1 Well Completion Report ' <br /> eerertalnn«cbn PampMef State Well Number/Site Number <br /> Ovmer's Well Number MW-2 No. o0095618 - <br /> Date Work Began 07/2012009 Date Work Ended 7/20/2009 Latitude Lon nude <br /> Local Permit Agency.San Joaauin County Environmental Health Denartment <br /> Permit Number 57817 Permit Date 7/15/09 APNrtRS/Other <br /> Geo to is Lo Well Owner <br /> Orientation OVertical O <br /> Set OAngle Speelfy Name Dalwinder Dhoot <br /> Drilling Method _ Drilling Fluid Mailing Address 15600 S.Harlan Road <br /> Depth from Surface Description LaAddre <br /> Feet to Feet Describe material min size wler,etc Cit State CA 71 <br /> Well destroyed b overdrillin to total de th. I Well Location <br /> Address 15688 S.Harlan Road <br /> City Lathrop County San Joaguln <br /> Latitude N Longitude ___yd <br /> Dee. Min. Sao Dee. Min SBC <br /> Datum Decimal Lat. Decimal Long. <br /> APN Book 196 Page 200 Parcel 17 j <br /> Tovmshl Ran2e Section <br /> Location Sketch AcN ' <br /> sketch must be drown b hand seer form w O New Weg <br /> North O ModificationfRepalr <br /> O Deepen <br /> O Other <br /> (D Destroy <br /> 0.«nbepativ«<M mel<XM. ' <br /> uM<r GEOLa31L LOG' <br /> Planned Uses <br /> — <br /> 0 Water Supply <br /> ❑Domestic ❑Publlc <br /> ❑Irrigation ❑Industrial <br /> .. O Cathodic Protection <br /> O Dewatemg <br /> O Heat Exchange <br /> O Injection <br /> O Monitoring ! <br /> O Remediation <br /> O Sparging <br /> " South O Test Well <br /> O Vapor Extraction II <br /> rNa.,Mc.ma.uwh.m<o.u.<.asum.lnro<r aaxe«ar. O Other <br /> Water Level and Yield of Completed Well <br /> Depth to first water (Feet below surface) <br /> Depth to Static <br /> Water Level (Feet) Date Measured <br /> Total Depth of Boring 16 Feet Estimated Yield (GPM) Test Type <br /> Total Depth of Completed Well Feet Test Length (Hours)Total Drawdown_(Feet) <br /> 'May not be representative of a weirs tong term yield. <br /> Casings Annular Material <br /> Depth from Borehole wall Outside Screen slut She, Depth hoe, <br /> Surface Dlamemr Typo Material Thickness Diameter Type if Any Surface FID Description <br /> Feet to Fast Inches Inches (Inches) Inches Feet to Feet <br /> Attachments CertlficaUon Statement <br /> ❑Geologic Log I,the undersigned,certifyy that this report is complete and accurate to the best of my knowledge and belief <br /> ❑Well Construction Diagram Name 1VDDdward Drilling <br /> ❑Geophysical Log(s)s person R.orC«p«nion <br /> 550 Riv r Road Rio Vista CA 94571 <br /> ❑ Soft Water Chemical Analyses <br /> (.'yrf MILW, Qty sena Zip <br /> ❑Other Signed (.JtTmJGr.rund d7-Zd-a9 710079 <br /> ARach atlEalonat keomretlon a to DLeOyed lar soul conkau« Date Sl ned C-57 License Number <br /> DI tea REV.IQ" IF ADDITIONAL SPACE IS NEEDED,USE NEXT CONSECUTIVELY NUMBERED FORM <br /> 1 <br />